G D Puippe1. 1. Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Schweiz. gilbert.puippe@usz.ch.
Abstract
BACKGROUND: Acute aortic dissection type B is a severe and life-threatening vascular emergency. Complications such as rupture and/or malperfusion of organs are the main reasons for early mortality. OBJECTIVES: The aim is to provide an overview on important diagnostic radiological findings, conservative as well as endovascular therapeutic options for patients presenting with rupture or malperfusion syndromes. RESULTS: Medical treatment consisting of blood pressure and heart rate control as well las adequate analgesia remains the cornerstone therapy of all type B aortic dissections. In case of organ malperfusion, various endovascular therapies, e. g., endoluminal fenestration of dissection flap, thoracic stent-graft implantation (TEVAR) or branch vessel stenting, are available. In the case of aortic rupture, TEVAR has become the standard owing to its lower mortality compared to open surgical repair. DISCUSSION: For the treatment of complicated type B aortic dissection, a number of endovascular options are available. For optimal treatment, profound knowledge of the disease, of the diagnostic workup, and of the interventional procedures is mandatory.
BACKGROUND: Acute aortic dissection type B is a severe and life-threatening vascular emergency. Complications such as rupture and/or malperfusion of organs are the main reasons for early mortality. OBJECTIVES: The aim is to provide an overview on important diagnostic radiological findings, conservative as well as endovascular therapeutic options for patients presenting with rupture or malperfusion syndromes. RESULTS: Medical treatment consisting of blood pressure and heart rate control as well las adequate analgesia remains the cornerstone therapy of all type B aortic dissections. In case of organ malperfusion, various endovascular therapies, e. g., endoluminal fenestration of dissection flap, thoracic stent-graft implantation (TEVAR) or branch vessel stenting, are available. In the case of aortic rupture, TEVAR has become the standard owing to its lower mortality compared to open surgical repair. DISCUSSION: For the treatment of complicated type B aortic dissection, a number of endovascular options are available. For optimal treatment, profound knowledge of the disease, of the diagnostic workup, and of the interventional procedures is mandatory.
Authors: M D Dake; N Kato; R S Mitchell; C P Semba; M K Razavi; T Shimono; T Hirano; K Takeda; I Yada; D C Miller Journal: N Engl J Med Date: 1999-05-20 Impact factor: 91.245
Authors: Loren F Hiratzka; George L Bakris; Joshua A Beckman; Robert M Bersin; Vincent F Carr; Donald E Casey; Kim A Eagle; Luke K Hermann; Eric M Isselbacher; Ella A Kazerooni; Nicholas T Kouchoukos; Bruce W Lytle; Dianna M Milewicz; David L Reich; Souvik Sen; Julie A Shinn; Lars G Svensson; David M Williams Journal: J Am Coll Cardiol Date: 2010-04-06 Impact factor: 24.094
Authors: Ahmad Zeeshan; Edward Y Woo; Joseph E Bavaria; Ronald M Fairman; Nimesh D Desai; Alberto Pochettino; Wilson Y Szeto Journal: J Thorac Cardiovasc Surg Date: 2010-12 Impact factor: 5.209
Authors: Himanshu J Patel; David M Williams; Meir Meerkov; Meir Meekov; Narasimham L Dasika; Gilbert R Upchurch; G Michael Deeb Journal: J Thorac Cardiovasc Surg Date: 2009-06-16 Impact factor: 5.209
Authors: Amit Jain; Margaret C Tracci; Dawn M Coleman; Kenneth J Cherry; Gilbert R Upchurch Journal: Semin Vasc Surg Date: 2014-06-12 Impact factor: 1.000
Authors: Foeke Jh Nauta; Santi Trimarchi; Arnoud V Kamman; Frans L Moll; Joost A van Herwaarden; Himanshu J Patel; C Alberto Figueroa; Kim A Eagle; James B Froehlich Journal: Vasc Med Date: 2016-04-11 Impact factor: 3.239
Authors: Frederik H W Jonker; Himanshu J Patel; Gilbert R Upchurch; David M Williams; Daniel G Montgomery; Thomas G Gleason; Alan C Braverman; Udo Sechtem; Rossella Fattori; Marco Di Eusanio; Arturo Evangelista; Christoph A Nienaber; Eric M Isselbacher; Kim A Eagle; Santi Trimarchi Journal: J Thorac Cardiovasc Surg Date: 2014-11-12 Impact factor: 5.209
Authors: Wilson Y Szeto; Michael McGarvey; Alberto Pochettino; G William Moser; Andrea Hoboken; Katherine Cornelius; Edward Y Woo; Jeffrey P Carpenter; Ronald M Fairman; Joseph E Bavaria Journal: Ann Thorac Surg Date: 2008-07 Impact factor: 4.330